Abdominal Computed Tomographic Scan for Patients with Gunshot Wounds to the Abdomen Selected for Nonoperative Management
BACKGROUND:Computed tomographic (CT) scanning is increasingly used in patients with abdominal gunshot wounds (AGSWs) selected for nonoperative management (NOM). Triple-contrast CT scanning (i.e., intravenous, oral, and rectal) has produced encouraging initial results. The exact role and usefulness o...
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| Veröffentlicht in: | The journal of trauma 2005-11, Vol.59 (5), p.1155-1161 |
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| container_title | The journal of trauma |
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| creator | Velmahos, George C. Constantinou, Constantinos Tillou, Areti Brown, Carlos V. Salim, Ali Demetriades, Demetrios |
| description | BACKGROUND:Computed tomographic (CT) scanning is increasingly used in patients with abdominal gunshot wounds (AGSWs) selected for nonoperative management (NOM). Triple-contrast CT scanning (i.e., intravenous, oral, and rectal) has produced encouraging initial results. The exact role and usefulness of CT scanning with intravenous contrast only is unknown.
METHODS:Hemodynamically stable AGSW patients without generalized abdominal tenderness were offered a trial of NOM, underwent single-contrast (intravenous) CT scanning, and were prospectively followed from July 1, 2002, to May 31, 2004. The sensitivity and specificity of CT scanning to detect organ injuries requiring repair were calculated against the clinical results of NOM. The effect of CT scanning in management was recorded.
RESULTS:One hundred patients with nontangential AGSWs were included. Twenty-six required laparotomy, which was nontherapeutic in five (19%). These five patients underwent operation on the basis of misleading CT findings (n = 3) or development of clinical symptoms (n = 2). Two CT scans were false-negative, and these patients were operated on at 121 and 307 minutes after arrival for hollow visceral injuries and recovered without postoperative complications. Three CT scans were false-positive and resulted in nontherapeutic laparotomies without postoperative complications. The sensitivity and specificity of CT scanning was 90.5% and 96%, respectively. CT findings resulted in a change of management in 40 patients. In nine, the decision to operate was changed to a decision to manage nonoperatively; whereas in eight, the opposite occurred. In addition, in 17, the decision to observe was changed to a decision to discharge; whereas in 1, the opposite occurred. Finally, five patients had additional tests after the findings of CT scanning.
CONCLUSION:Abdominal CT scanning is a safe and useful method of selecting AGSW patients for NOM. Further exploration is needed to define the precise benefits of routine CT scanning over clinical examination with selective CT scanning. |
| doi_str_mv | 10.1097/01.ta.0000196435.18073.6d |
| format | Article |
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METHODS:Hemodynamically stable AGSW patients without generalized abdominal tenderness were offered a trial of NOM, underwent single-contrast (intravenous) CT scanning, and were prospectively followed from July 1, 2002, to May 31, 2004. The sensitivity and specificity of CT scanning to detect organ injuries requiring repair were calculated against the clinical results of NOM. The effect of CT scanning in management was recorded.
RESULTS:One hundred patients with nontangential AGSWs were included. Twenty-six required laparotomy, which was nontherapeutic in five (19%). These five patients underwent operation on the basis of misleading CT findings (n = 3) or development of clinical symptoms (n = 2). Two CT scans were false-negative, and these patients were operated on at 121 and 307 minutes after arrival for hollow visceral injuries and recovered without postoperative complications. Three CT scans were false-positive and resulted in nontherapeutic laparotomies without postoperative complications. The sensitivity and specificity of CT scanning was 90.5% and 96%, respectively. CT findings resulted in a change of management in 40 patients. In nine, the decision to operate was changed to a decision to manage nonoperatively; whereas in eight, the opposite occurred. In addition, in 17, the decision to observe was changed to a decision to discharge; whereas in 1, the opposite occurred. Finally, five patients had additional tests after the findings of CT scanning.
CONCLUSION:Abdominal CT scanning is a safe and useful method of selecting AGSW patients for NOM. Further exploration is needed to define the precise benefits of routine CT scanning over clinical examination with selective CT scanning.</description><identifier>ISSN: 0022-5282</identifier><identifier>EISSN: 1529-8809</identifier><identifier>DOI: 10.1097/01.ta.0000196435.18073.6d</identifier><identifier>PMID: 16385294</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins, Inc</publisher><subject>Abdominal Injuries - diagnostic imaging ; Abdominal Injuries - therapy ; Adolescent ; Adult ; Aged ; Colon - injuries ; Female ; Humans ; Kidney - injuries ; Length of Stay ; Liver - injuries ; Male ; Middle Aged ; Sensitivity and Specificity ; Spleen - injuries ; Stomach - injuries ; Tomography, X-Ray Computed ; Wounds, Gunshot - diagnostic imaging ; Wounds, Gunshot - therapy</subject><ispartof>The journal of trauma, 2005-11, Vol.59 (5), p.1155-1161</ispartof><rights>2005 Lippincott Williams & Wilkins, Inc.</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3601-20abe88c1aa19c623c414e3d2a7aa563a2b828ec56e32dfdb97bf36d8960325e3</citedby><cites>FETCH-LOGICAL-c3601-20abe88c1aa19c623c414e3d2a7aa563a2b828ec56e32dfdb97bf36d8960325e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16385294$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Velmahos, George C.</creatorcontrib><creatorcontrib>Constantinou, Constantinos</creatorcontrib><creatorcontrib>Tillou, Areti</creatorcontrib><creatorcontrib>Brown, Carlos V.</creatorcontrib><creatorcontrib>Salim, Ali</creatorcontrib><creatorcontrib>Demetriades, Demetrios</creatorcontrib><title>Abdominal Computed Tomographic Scan for Patients with Gunshot Wounds to the Abdomen Selected for Nonoperative Management</title><title>The journal of trauma</title><addtitle>J Trauma</addtitle><description>BACKGROUND:Computed tomographic (CT) scanning is increasingly used in patients with abdominal gunshot wounds (AGSWs) selected for nonoperative management (NOM). Triple-contrast CT scanning (i.e., intravenous, oral, and rectal) has produced encouraging initial results. The exact role and usefulness of CT scanning with intravenous contrast only is unknown.
METHODS:Hemodynamically stable AGSW patients without generalized abdominal tenderness were offered a trial of NOM, underwent single-contrast (intravenous) CT scanning, and were prospectively followed from July 1, 2002, to May 31, 2004. The sensitivity and specificity of CT scanning to detect organ injuries requiring repair were calculated against the clinical results of NOM. The effect of CT scanning in management was recorded.
RESULTS:One hundred patients with nontangential AGSWs were included. Twenty-six required laparotomy, which was nontherapeutic in five (19%). These five patients underwent operation on the basis of misleading CT findings (n = 3) or development of clinical symptoms (n = 2). Two CT scans were false-negative, and these patients were operated on at 121 and 307 minutes after arrival for hollow visceral injuries and recovered without postoperative complications. Three CT scans were false-positive and resulted in nontherapeutic laparotomies without postoperative complications. The sensitivity and specificity of CT scanning was 90.5% and 96%, respectively. CT findings resulted in a change of management in 40 patients. In nine, the decision to operate was changed to a decision to manage nonoperatively; whereas in eight, the opposite occurred. In addition, in 17, the decision to observe was changed to a decision to discharge; whereas in 1, the opposite occurred. Finally, five patients had additional tests after the findings of CT scanning.
CONCLUSION:Abdominal CT scanning is a safe and useful method of selecting AGSW patients for NOM. Further exploration is needed to define the precise benefits of routine CT scanning over clinical examination with selective CT scanning.</description><subject>Abdominal Injuries - diagnostic imaging</subject><subject>Abdominal Injuries - therapy</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Colon - injuries</subject><subject>Female</subject><subject>Humans</subject><subject>Kidney - injuries</subject><subject>Length of Stay</subject><subject>Liver - injuries</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Sensitivity and Specificity</subject><subject>Spleen - injuries</subject><subject>Stomach - injuries</subject><subject>Tomography, X-Ray Computed</subject><subject>Wounds, Gunshot - diagnostic imaging</subject><subject>Wounds, Gunshot - therapy</subject><issn>0022-5282</issn><issn>1529-8809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkFtv1DAQhS0EotvCX0DmhbcEXxKv81itoFQqF6lFPFoTe9IEkjjYDgv_Hu9F6kijkaXvnPEcQt5yVnLWbN8zXiYoWS7eqErWJddsK0vlnpENr0VTaM2a52TDmBBFLbS4IJcx_sx8VUn9klxwJXXmqg35e906Pw0zjHTnp2VN6OiDn_xjgKUfLL23MNPOB_oN0oBzinQ_pJ7erHPsfaI__Dq7SJOnqUd69MKZ3uOI9uB0EH7xs18wZPkfpJ9hhkfMTHpFXnQwRnx9nlfk-8cPD7tPxd3Xm9vd9V1hpWK8EAxa1NpyAN5YJaSteIXSCdgC1EqCaLXQaGuFUrjOtc227aRyulFMihrlFXl38l2C_71iTGYaosVxhBn9Go1qWM2FZBlsTqANPsaAnVnCMEH4Zzgzh9gN4yaBeYrdHGM3ymXtm_OStZ3QPSnPOWegOgF7PyYM8de47jGYHmFM_dGylluZr82f4flV5BZc_geWX5BT</recordid><startdate>200511</startdate><enddate>200511</enddate><creator>Velmahos, George C.</creator><creator>Constantinou, Constantinos</creator><creator>Tillou, Areti</creator><creator>Brown, Carlos V.</creator><creator>Salim, Ali</creator><creator>Demetriades, Demetrios</creator><general>Lippincott Williams & Wilkins, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200511</creationdate><title>Abdominal Computed Tomographic Scan for Patients with Gunshot Wounds to the Abdomen Selected for Nonoperative Management</title><author>Velmahos, George C. ; Constantinou, Constantinos ; Tillou, Areti ; Brown, Carlos V. ; Salim, Ali ; Demetriades, Demetrios</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3601-20abe88c1aa19c623c414e3d2a7aa563a2b828ec56e32dfdb97bf36d8960325e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Abdominal Injuries - diagnostic imaging</topic><topic>Abdominal Injuries - therapy</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Colon - injuries</topic><topic>Female</topic><topic>Humans</topic><topic>Kidney - injuries</topic><topic>Length of Stay</topic><topic>Liver - injuries</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Sensitivity and Specificity</topic><topic>Spleen - injuries</topic><topic>Stomach - injuries</topic><topic>Tomography, X-Ray Computed</topic><topic>Wounds, Gunshot - diagnostic imaging</topic><topic>Wounds, Gunshot - therapy</topic><toplevel>online_resources</toplevel><creatorcontrib>Velmahos, George C.</creatorcontrib><creatorcontrib>Constantinou, Constantinos</creatorcontrib><creatorcontrib>Tillou, Areti</creatorcontrib><creatorcontrib>Brown, Carlos V.</creatorcontrib><creatorcontrib>Salim, Ali</creatorcontrib><creatorcontrib>Demetriades, Demetrios</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The journal of trauma</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Velmahos, George C.</au><au>Constantinou, Constantinos</au><au>Tillou, Areti</au><au>Brown, Carlos V.</au><au>Salim, Ali</au><au>Demetriades, Demetrios</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Abdominal Computed Tomographic Scan for Patients with Gunshot Wounds to the Abdomen Selected for Nonoperative Management</atitle><jtitle>The journal of trauma</jtitle><addtitle>J Trauma</addtitle><date>2005-11</date><risdate>2005</risdate><volume>59</volume><issue>5</issue><spage>1155</spage><epage>1161</epage><pages>1155-1161</pages><issn>0022-5282</issn><eissn>1529-8809</eissn><abstract>BACKGROUND:Computed tomographic (CT) scanning is increasingly used in patients with abdominal gunshot wounds (AGSWs) selected for nonoperative management (NOM). Triple-contrast CT scanning (i.e., intravenous, oral, and rectal) has produced encouraging initial results. The exact role and usefulness of CT scanning with intravenous contrast only is unknown.
METHODS:Hemodynamically stable AGSW patients without generalized abdominal tenderness were offered a trial of NOM, underwent single-contrast (intravenous) CT scanning, and were prospectively followed from July 1, 2002, to May 31, 2004. The sensitivity and specificity of CT scanning to detect organ injuries requiring repair were calculated against the clinical results of NOM. The effect of CT scanning in management was recorded.
RESULTS:One hundred patients with nontangential AGSWs were included. Twenty-six required laparotomy, which was nontherapeutic in five (19%). These five patients underwent operation on the basis of misleading CT findings (n = 3) or development of clinical symptoms (n = 2). Two CT scans were false-negative, and these patients were operated on at 121 and 307 minutes after arrival for hollow visceral injuries and recovered without postoperative complications. Three CT scans were false-positive and resulted in nontherapeutic laparotomies without postoperative complications. The sensitivity and specificity of CT scanning was 90.5% and 96%, respectively. CT findings resulted in a change of management in 40 patients. In nine, the decision to operate was changed to a decision to manage nonoperatively; whereas in eight, the opposite occurred. In addition, in 17, the decision to observe was changed to a decision to discharge; whereas in 1, the opposite occurred. Finally, five patients had additional tests after the findings of CT scanning.
CONCLUSION:Abdominal CT scanning is a safe and useful method of selecting AGSW patients for NOM. Further exploration is needed to define the precise benefits of routine CT scanning over clinical examination with selective CT scanning.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>16385294</pmid><doi>10.1097/01.ta.0000196435.18073.6d</doi><tpages>7</tpages></addata></record> |
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| subjects | Abdominal Injuries - diagnostic imaging Abdominal Injuries - therapy Adolescent Adult Aged Colon - injuries Female Humans Kidney - injuries Length of Stay Liver - injuries Male Middle Aged Sensitivity and Specificity Spleen - injuries Stomach - injuries Tomography, X-Ray Computed Wounds, Gunshot - diagnostic imaging Wounds, Gunshot - therapy |
| title | Abdominal Computed Tomographic Scan for Patients with Gunshot Wounds to the Abdomen Selected for Nonoperative Management |
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